Case managers' roles and functions: Commission for Case Manager Certification's 2004 research, part II

The Commission for Case Manager Certification (CCMC) conducted its third case managers' role and functions study in 2004 for the purpose of validating the currency and relevancy of the certified case manager examination. The results of this study are shared in an article of 2 parts. Part I, which was published in the previous issue of this journal, discussed the process the CCMC used for the development of the Case Managers' Role and Functions Survey Instrument and the identification of new 6 essential functions and 6 knowledge areas that describe case management practice. These findings were based on the survey of a large national sample of practicing case managers. Part II continues the analysis of the results and focuses on identifying the empirical (statistically derived) activity and knowledge domains of case management practice, using exploratory factor analysis. It discusses the similarities and differences found among various subgroups of case managers who were compared on the basis of certain demographic variables. In addition, Part II summarizes future changes in the field of case management as perceived by those who participated in the study.     

Health care managers' and administrators' roles, functions, and responsibilities.

Health care managers and administrators are increasingly assuming leadership and management responsibilities for multiple units and departments. To determine key roles, functions, and responsibilities of nursing and other health care managers and administrators, a survey was conducted to identify the perceived importance and amount of time these individuals devote to selected activities. Although the amount of time and perceived importance of selected activities varied with each environmental context, some key roles, functions, and responsibilities across practice disciplines did emerge. Regardless of the environmental context, administrators and managers at all levels in health care organizations spend significant amounts of time and place high value on communication, problem solving and decision making, collaboration with other disciplines, people development, and cost containment.     

A synthesis of the effects of occupational therapy for persons with stroke, Part I: Restoration of roles, tasks, and activities.

This article synthesizes research findings regarding the effects of occupational therapy on the restoration of role, task, and activity performance for persons who have had a stroke, with the purpose of guiding practice and research. It is the first of a two-part review of studies. Part II synthesizes research findings regarding the effects of occupational therapy on remediating impairments. Part I includes 15 studies involving 895 participants (mean age = 70.3 years). Of these studies, 11 (7 randomized controlled trials) found that role participation and instrumental and basic activities of daily living performance improved significantly more with training than with the control conditions. We conclude that occupational therapy effectively improves participation and activity after stroke and recommend that therapists use structured instruction in specific, client-identified activities, appropriate adaptations to enable performance, practice within a familiar context, and feedback to improve client performance. Empirical research to verify these findings and to characterize the key therapeutic mechanisms associated with desired outcomes is needed.     

A Collaborative Approach to Nursing Research: Part I, the Process

Although many nurse practitioners may be interested in documenting aspects of their practice through research, resource and time constraints can limit the opportunity. Collaboration can be a practical and rewarding approach to making research feasible for clinicians. Under the auspices of a professional nursing organization, a group of San Francisco Bay area nurse practitioners conducted a survey designed primarily to increase membership in their organization. This article details the process by which the research was conducted and serves as a guide for clinicians about to undertake a similar project.     

Assertive outreach teams: Their roles and functions

This critical evaluation considers research literature on Assertive Outreach Teams (AOTs). The extensive examination of this multi-professional service configuration is contrasted with the under-defined and untested nature of the service interventions that are provided by these teams. An audit of crisis management work in an AOT is reported and twelve areas of “life difficulties” are identified. An attempt to measure these life difficulties is then described. The use of this measurement for prioritizing referrals, managing workloads, agreeing care plans and measuring outcomes is discussed. Finally, the inadequacy of existing research approaches and associated problems in the separation of management and clinical practices are considered.     

Assertive outreach teams: their roles and functions

This critical evaluation considers research literature on Assertive Outreach Teams (AOTs). The extensive examination of this multi-professional service configuration is contrasted with the under-defined and untested nature of the service interventions that are provided by these teams. An audit of crisis management work in an AOT is reported and twelve areas of "life difficulties" are identified. An attempt to measure these life difficulties is then described. The use of this measurement for prioritizing referrals, managing workloads, agreeing care plans and measuring outcomes is discussed. Finally, the inadequacy of existing research approaches and associated problems in the separation of management and clinical practices are considered.     

残疾儿童综合功能评定法的研究：（一）设计

为制定一个客观、全面的反映残疾儿童障碍的评定标准,我们参照国外资料,并以在临床中应用11年的脑瘫儿童日常生活活动能力评价表为基础,设计了残疾儿童综合功能评定法,内容主要包括认知功能,粗大运动功能,语言功能,自理动作和社会适应5个方面,共50项内容,采用百分制评分标准,制定了障碍程度及疗效评定标准。     

Qualitative Research in Emergency Care Part I: Research Principles and Common Applications

Qualitative methods are increasingly being used in emergency care research. Rigorous qualitative methods can play a critical role in advancing the emergency care research agenda by allowing investigators to generate hypotheses, gain an in‐depth understanding of health problems or specific populations, create expert consensus, and develop new intervention and dissemination strategies. This article, Part I of a two‐article series, provides an introduction to general principles of applied qualitative health research and examples of its common use in emergency care research, describing study designs and data collection methods most relevant to our field, including observation, individual interviews, and focus groups. In Part II of this series, we will outline the specific steps necessary to conduct a valid and reliable qualitative research project, with a focus on interview‐based studies. These elements include building the research team, preparing data collection guides, defining and obtaining an adequate sample, collecting and organizing qualitative data, and coding and analyzing the data. We also discuss potential ethical considerations unique to qualitative research as it relates to emergency care research.     

Artificial urinary sphincter, Part I: Overview

Urinary incontinence has a tremendous impact on an individual's quality of life and self-esteem. A number of patients will fail both conservative medical as well as conservative surgical treatments in their pursuit to regain urinary control. The surgical implantation of an artificial urinary sphincter (AUS) is a definitive surgical option to reestablish continence. However, there are many challenges that may arise as a patient progresses through the rigorous preparation, surgical procedure, and recovery process. Understanding the history, various indications, and risks of AUS surgery will aid in counseling patients considering AUS.     

Acute Coronary Syndromes: Diagnosis and Management, Part I

The term acute coronary syndrome (ACS) refers to any group of clinical symptoms compatible with acute myocardial ischemia and includes unstable angina (UA), non—ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). These high-risk manifestations of coronary atherosclerosis are important causes of the use of emergency medical care and hospitalization in the United States. A quick but thorough assessment of the patient''s history and findings on physical examination, electrocardiography, radiologic studies, and cardiac biomarker tests permit accurate diagnosis and aid in early risk stratification, which is essential for guiding treatment. High-risk patients with UA/NSTEMI are often treated with an early invasive strategy involving cardiac catheterization and prompt revascularization of viable myocardium at risk. Clinical outcomes can be optimized by revascularization coupled with aggressive medical therapy that includes anti-ischemic, antiplatelet, anticoagulant, and lipid-lowering drugs. Evidence-based guidelines provide recommendations for the management of ACS; however, therapeutic approaches to the management of ACS continue to evolve at a rapid pace driven by a multitude of large-scale randomized controlled trials. Thus, clinicians are frequently faced with the problem of determining which drug or therapeutic strategy will achieve the best results. This article summarizes the evidence and provides the clinician with the latest information about the pathophysiology, clinical presentation, and risk stratification of ACS and the management of UA/NSTEMI.ACC = American College of Cardiology; ACE = angiotensin-converting enzyme; ACS = acute coronary syndrome; ADP = adenosine diphosphate; AHA = American Heart Association; BNP = B-type natriuretic peptide; CABG = coronary artery bypass grafting; CAD = coronary artery disease; CHF = congestive heart failure; CI = confidence interval; CK-MB = muscle and brain fraction of creatine kinase; CRP = C-reactive protein; CURE = Clopidogrel in Unstable Angina to Prevent Recurrent Events; ECG = electrocardiography; ED = emergency department; GP = glycoprotein; HR = hazard ratio; IV = intravenous; LDL = low-density lipoprotein; LMWH = low—molecular-weight heparin; LV = left ventricular; MI = myocardial infarction; NSTEMI = non—ST-segment elevation MI; PCI = percutaneous coronary intervention; STEMI = ST-segment elevation MI; TIMI = Thrombolysis in Myocardial Infarction; UA = unstable angina; UFH = unfractionated heparinThe term acute coronary syndrome (ACS) refers to any group of clinical symptoms compatible with acute myocardial ischemia and covers the spectrum of clinical conditions ranging from unstable angina (UA) to non—ST-segment elevation myocardial infarction (NSTEMI) to ST-segment elevation myocardial infarction (STEMI). Unstable angina and NSTEMI are closely related conditions: their pathophysiologic origins and clinical presentations are similar, but they differ in severity. A diagnosis of NSTEMI can be made when the ischemia is sufficiently severe to cause myocardial damage that results in the release of a biomarker of myocardial necrosis into the circulation (cardiac-specific troponins T or I, or muscle and brain fraction of creatine kinase [CK-MB]). In contrast, the patient is considered to have experienced UA if no such biomarker can be detected in the bloodstream hours after the initial onset of ischemic chest pain. Unstable angina exhibits 1 or more of 3 principal presentations: (1) rest angina (usually lasting >20 minutes), (2) new-onset (<2 months previously) severe angina, and (3) a crescendo pattern of occurrence (increasing in intensity, duration, frequency, or any combination of these factors). Each year in the United States, approximately 1.36 million hospitalizations are required for ACS (listed either as a primary or a secondary discharge diagnosis), of which 0.81 million are for myocardial infarction (MI) and the remainder are for UA. Roughly two-thirds of patients with MI have NSTEMI; the rest have STEMI.¹     

Heavy Metal Toxicity,Part I: Arsenic and Mercury

This review is Part I of a two-part series focusing on heavy metal toxicity. Part I will cover arsenic and mercury toxicity. Acute and chronic arsenic toxicity, as well as arsine gas toxicity, will be reviewed. The clinical presentation, with focus on the nervous, cardiovascular, pulmonary, gastrointestinal, hepatic, renal, hematopoietic, and dermatologic systems, is delineated. Mercury exposure, including exposure to short chain alkyl mercury, elemental mercury, and acute inorganic salt, is reviewed. The discussion of clinical toxicity focuses on the nervous, cardiovascular, pulmonary, gastrointestinal, and renal systems, as well as on the teratogenic effects of mercury. Recommendations for diagnostic tests and management plans are discussed, including chelation regimens.